| Doctor Name: | THERESA KOHLRUSCH |
| NPI Number: | 1134127319 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 858 |
| Business Practice Address: | 265 Griffin St E Amery, WI - 540011439 |
| Business Phone Number: | 7152688000 |
| Business Fax Number: | 7152680311 |
| Mailing Address: | 265 Griffin Street East, AMERY |
| State: | WI |
| Postal Code: | 54001 |
| Phone Number: | 7152688000 |
| Fax Number: | 7152680308 |
| NPI Enumeration Date: | 07/12/2005 |
| NPI Last Update Date: | 05/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 858 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |